Towards an actionable One Health approach.

BACKGROUND: Despite the increasing focus on strengthening One Health capacity building on global level, challenges remain in devising and implementing real-world interventions particularly in the Asia-Pacific region. Recognizing these gaps, the One Health Action Commission (OHAC) was established as an academic community for One Health action with an emphasis on research agenda setting to identify actions for highest impact. MAIN TEXT: This viewpoint describes the agenda of, and motivation for, the recently formed OHAC. Recognizing the urgent need for evidence to support the formulation of necessary action plans, OHAC advocates the adoption of both bottom-up and top-down approaches to identify the current gaps in combating zoonoses, antimicrobial resistance, addressing food safety, and to enhance capacity building for context-sensitive One Health implementation. CONCLUSIONS: By promoting broader engagement and connection of multidisciplinary stakeholders, OHAC envisions a collaborative global platform for the generation of innovative One Health knowledge, distilled practical experience and actionable policy advice, guided by strong ethical principles of One Health.

A prospective study of snakebite in a tertiary care hospital in south-western Nepal.

BACKGROUND: Snakebite is a neglected public health issue in Nepal. We aimed to characterize patients with snake envenoming admitted to hospital in south-western Nepal. METHODS: This was a prospective cohort study of 476 snakebite patients admitted to Bheri Hospital from May to December 2017. Data were collected on patient demographics, bite circumstances, snake type, treatment-seeking behavior, clinical effects, complications and treatment. RESULTS: There were 139/476 (29%) patients with clinical features of envenomation and 10 deaths (8%), of which six were prehospital deaths; 325/476 (68%) patients used non-recommended prehospital first aid, including 278 (58%) who applied a tourniquet and 43 (9%) consulting traditional healers. Median time to hospital arrival was 1.5 (IQR: 0.8-4) h. Also, 127 envenomated patients (91%) developed neurotoxicity and 12 (9%) hemotoxicity, while 124 patients (89%) received antivenom, with a median dose of 10 (4-30) vials. Three patients developed anaphylaxis following antivenom administration; 111 of 139 (80%) cases were admitted to the ICU and 48 (35%) were intubated. Median length of hospital stay for all cases was 0.5 (IQR: 0.5-1.2) d, but it was 2.2 (IQR: 1.5-3.8) d for envenomated cases. CONCLUSIONS: The majority of snakebite patients used non-recommended first aid or attended traditional healers. Almost one-third of patients developed systemic envenomation and required antivenom. The case fatality rate was high, but many died prior to arriving in hospital.

Breastfeeding and impact on childhood hospital admissions: a nationwide birth cohort in South Korea.

Benefits of breastfeeding for both the mother and the child are well established, but a comprehensive and robust study to investigate the protective effect of breastfeeding and attenuated time effect stratified by cause of morbidity are lacking. This study is based on the nationwide birth cohort in Korea that includes data on all infants born from 2009 to 2015. Of 1,608,540 children, the median follow-up period was 8.41 years (interquartile range, 6.76-10.06). When compared to children with fully formula feeding, the hospital admission rate was 12% lower in those with partially breastfeeding and 15% lower in those with exclusive breastfeeding. The apparent protective effect of breastfeeding was reduced with increasing age. Our study provides potential evidence of the beneficial association of breastfeeding on subsequent hospital admissions. The protective effect declined over time as the children grew older. Encouraging any breastfeeding for at least the first 6 months among infants is an important public health strategy to improve overall child health.

Ecological and Socioeconomic Factors in the Occurrence of Rabies: A Forgotten Scenario.

In many third world countries, where rabies is endemic in dog populations, humans continue to be at risk of contracting the disease. Vaccination is the most effective form of prophylaxis for people, yet it often fails to adequately protect dogs. The most major implications are the costs of post-exposure prophylaxis (PEP) after an exposure occurs and the loss of human life and productivity due to early mortality from rabies (about 60,000 deaths annually). The largest rabies death tolls can be found in the world's poorest regions, where rabies vaccinations for domestic dogs are uncommon and PEP is scarce. Mass vaccination of dogs, neutering programs, patient PEP, strengthening laboratory and human resources, education and awareness, and animal and human rabies surveillance are all common methods used to prevent, control, and ultimately eradicate dog-mediated human rabies. Current rabies control initiatives, however, pay little attention to the role that ecological and socioeconomic variables play in the disease's occurrence and spread. To help better inform rabies control strategies, we address in this work the ways in which ecological and socioeconomic factors affect the occurrence and spread of rabies.

Rabies Elimination: Is It Feasible without Considering Wildlife?

Rabies is a vaccine-preventable fatal viral disease that is zoonotic in nature. In this article, we provide a justification why the agreement of the World Health Organization (WHO), the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and Global Alliance for Rabies Control (GARC) on The Global Strategic Plan to End Human Deaths from Dog-mediated Rabies by 2030 should also include a more holistic approach and ecologic views.

Corrigendum: Applied Research in Low-Income Countries: Why and How?

[This corrects the article DOI: 10.3389/frma.2019.00003.].

Rabies control in South Asia requires a One Health approach.

Rabies is a vaccine-preventable viral disease present in more than 150 countries around the world. Globally, almost 60,000 people die each year from rabies, of which more than 58% are in Asia and around 45% in South Asia with especially high incidence in India, Pakistan and Bangladesh. Vaccination coverage of both people and stray dogs is low in the region and in general people are not given enough protection and information about pre- and post-exposure prophylaxis. Engagement of multiple sectors and One Health collaboration including community education, awareness programmes and vaccination campaigns are critical to control and elimination of rabies.

Current scenario of and future perspective for scientific research in Nepal.

Scientific research can act as the 'bedrock for development' which can provide a solid foundation for the overall socioeconomic transformation in a country through invention and innovation. The inclusion of seven groups of Nepalese monuments in the United Nations Educational, Scientific and Cultural Organization (UNESCO)'s world heritage sites provides evidence of the richness in architecture and civil engineering in the country, which also show how Nepal was influenced by arts and religious philosophy. The government of Nepal (GoN) has established different scientific departments, universities, and research institutions, and has tried to emphasize the application of science and research for the development of the nation. These institutions, however, have inadequate resources, exist in a poor academic and research environment and are subject to overt political influence. Despite these various problems, a variety of pioneer research and development activities have been conducted, which show positive rays of hope. This review presents history, current situation, progress and future perspective for scientific research and development in Nepal.

The potential impact of the COVID-19 pandemic on antimicrobial resistance and antibiotic stewardship.

The rapid emergence and spread of antimicrobial resistance continue to kill an estimated 700,000 people annually, and this number is projected to increase ten-fold by 2050. With the lack of data, it is uncertain how the COVID-19 pandemic will affect antimicrobial resistance. Severe disruption of research, innovation, global health programs, and compromised antimicrobial stewardship, infection prevention and control programs, especially in low-and middle-income countries, could affect antimicrobial resistance. However, factors such as strict lockdown, social distancing, vaccination, and the extensive implementation of hand hygiene and face masks, with limited international travel and migration, may also contribute to decreasing AMR. Although the impact of COVID-19 on AMR is global, the adverse effect is likely to be worse in LMICs. In this article, we explore the possible impact of the current pandemic on antibiotic resistance.

The Role of Waste Management in Control of Rabies: A Neglected Issue.

Despite being vaccine preventable, the global burden of dog rabies remains significant, and historically it is the rural and marginalized communities in developing countries of Africa and Asia that are most threatened by the disease. In recent years, the developing world has been experiencing unprecedented increases in urbanization, with a correspondingly massive increase in municipal solid waste generation, among other things. Inefficient and inadequate waste collection and management, due to lack of resources and planning, led to significant increases in the volumes of waste on the streets and in open dumps, where it serves as food sources for free-roaming dogs. In this commentary, we discuss examples of poor waste management and the likely impact on rabies control efforts through the sustenance of free-roaming dogs in some dog rabies-endemic countries. We aim to stress the importance of implementing strategies that effectively address this particular issue as an important component of humane dog population management, as it relates to aspirations for the control and elimination of dog rabies per se.

Methicillin-resistant Staphylococcus aureus in Nepal.

Staphylococcus aureus is both a frequent commensal and a leading cause of endocarditis, bacteremia, osteomyelitis and skin and soft tissue infections and device-related infections. We performed this minireview to summarize the prevalence of Staphylococcus aureus among clinical samples and estimate the proportion of methicillin-resistant Staphylococcus aureus. The prevalence of Staphylococcus aureus among clinical isolates in Nepal is 34.5%. On average, the proportion of multi-drug resistance in Staphylococcus aureus is 57.1%. Methicillin-resistant Staphylococcus aureus accounts for a total of 41.7%. Inducible clindamycin resistance was detected in about 35% of the isolates. A regular antimicrobial resistance surveillance mechanism is necessary to mitigate the development of resistance among organisms and further spread of superbugs like methicillin-resistance Staphylococcus aureus.

Nepal at the edge of sword with two edges: The COVID-19 pandemics and sustainable development goals.

Humanity has been threatened by pandemics since several decades with devastating effects on all human activities including the economy, and environment. Currently, the world is reeling from the COVID-19 pandemic. The COVID-19 pandemic has been a major threat to the livelihood of billions of people worldwide. Nepal is not an exception to this and has been seriously threatened by the COVID-19 pandemic. The thousands of the peoples who depend on daily wages to join hand to mouth has been under the brunt of the COVID-19 pandemic because of job loss, disruption in the food supply chain. Also, the COVID-19 pandemic has thwarted Nepal's targets to achieve UN Sustainable Development Goals including an unprecedented state of vulnerability to hunger and poverty in the country. Though some informal shreds of evidence have reported the negative impacts of COVID-19 on Sustainable Development Goals, none of the scientific literature has been available regarding such impacts in Nepal yet. This review aims to synthesize extant literature that reports the effects of COVID-19 on the Nepalese economy and implications for achieving UN Sustainable Development Goals.We found that the COVID-19 pandemic has created unprecedented challenges to achieve the country's committed United Nation's Sustainable Development Goals for Nepal. Further, the COVID-19 pandemic has created a unique "income shock" that is supposed to precipitate household food insecurity in developing economy like Nepal. Our review indicated that the percentage of populations below poverty could rise even more than the present national reported value of 18% in the post-pandemic era. We emphasized generating employment and income-earning opportunities to build a resilient food system. Further, we urged to build international consensus to reset and rethink the course of sustainable development goals.

Distribution and habitat attributes associated with the Himalayan red panda in the westernmost distribution range.

The Himalayan red panda (Ailurus fulgens), a recently confirmed distinct species in the red panda genus, is distributed in Nepal, India, Bhutan, and south Tibet. Nepal represents the westernmost distribution of the Himalayan red panda. This study aims to determine important habitat features influencing the distribution of red panda and recommend possible habitat corridors. This manuscript described current potential habitat of 3,222 km2 with the relative abundance of 3.34 signs/km in Nepal. Aspect, canopy cover, bamboo cover, and distance to water were the important habitat attributes. It suggested five potential corridors in western Nepal. Overall, the study has important implications for conservation of the Himalayan red panda in western distribution range.

PPR control program in Nepal: What next?

PPR is an economically important trans-boundary disease of sheep and goats. Nepal had experienced several episodes of PPR outbreaks in the past. Although severity and frequency of outbreaks have decreased due to strenuous effort of Government of Nepal, it has been rather endemic. National PPR Control Program 2001, and PPR Control Program Implementation Working Guidelines, 2013, the legal documents guiding PPR control activities, have not been effective as expected due to multifactorial reasons. Thus, a critical analysis of the program with emphasis on impeding factors is must. In this review, we attempted to analyse and suggest more effective strategies considering geopolitical, social and cultural context of Nepal.

The animal sacrifice-public health nexus in Nepal.

Participants in religious festivals have practiced animal sacrifice as a core part of Hinduism for hundreds of years-at a small scale by individuals and at large scale at major festivals. Butchers frequently perform sacrificial slaughter openly, in sight and sound of other animals with little or no guidance from or adherence to hygienic standards, which are poor or non-existent. One Health principles could guide development of interventions to protect human and animal health and welfare from these practices, but this concept is poorly understood in Nepal. Animal welfare organizations and international outcry have prompted some action through the Supreme Court, but the result fell short of a ban and little has been done in the face of religious considerations. Public health agencies and policymakers must act to implement effective regulations and enforce laws to prevent the human, animal, and environmental health risks surrounding these inhumane and unhygienic practices in order to ensure the protection of animal welfare and public health.

Correction to: Human infection with Avian Influenza A virus in Nepal: requisite for timely management and preparedness.

[This corrects the article DOI: 10.1007/s13337-020-00593-z.].

Human infection with Avian influenza A virus in Nepal: requisite for timely management and preparedness.

Avian influenza virus infection in humans is an emerging zoonotic disease having high economic and public health impacts. Due to its capability for genetic re-assortment, this virus can emerge as novel influenza strains with pandemic potential. Even though the first Avian influenza incidence in humans in Nepal was reported in April 2019, the threat of the disease remains unmitigated. Limited resources for surveillance, disease tracking, and weak health care facilities in low and middle-income countries will increase the possibility of the outbreak. Therefore, timely management and preparedness by strengthening veterinary and medical services, operational capabilities of laboratories, and surveillance programs through the "One-Health" approach could be crucial for the control of possible outbreaks in Nepal.

One-health approach: A best possible way to control rabies.

More than 75% of emerging infectious diseases and 60% of known human infectious diseases are transmitted from animals. Among these zoonoses, rabies is of utmost public health significance due to its lethality. The multi-faceted nature of zoonotic disease complicates control and prevention and thus, a multi-sectoral One Health Approach could be a better strategy to cope with rabies. Up until now, rabies prevention and control programs are conducted utilizing mass vaccination of domestic and community dogs and cats, and mass awareness programs. However, the burden of rabies has not been reduced as these approaches have failed to include all stakeholders (human, animal, and environmental health sectors) in disease management programs. The aim of this review is to highlight why and how One Health Approach would be the most effective way to control rabies in low- and middle-income countries (LMICs) like Nepal.